Individual
JONATHAN D SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
242 BRUNSWICK ST, OLD TOWN, ME 04468-1613
(207) 827-6128
(207) 827-5533
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 945-5247
(207) 947-0435
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LS12886
ME
Other
Enumeration date
10/11/2011
Last updated
10/11/2011
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